Large trusts win under new starratings rule

Large trusts will no longer be unfairly penalised for their performance against waiting-list targets, thanks to changes to this year's star-ratings system.

Until now, trusts had been allowed an absolute number of breaches of inpatient and outpatient waiting targets before they failed on related indicators.

The same number of breaches was set for each category regardless of the total number of patients a trust treated - leading large trusts to complain that the system judged them too harshly.

Now the Commission for Health Improvement has announced changes to the system, which will be taken over by the Commission for Healthcare Audit and Inspection next month, so that the number of breaches will be measured as a percentage of the total number of patients a trust treats.

CHI said the changes came partly in response to last summer's bitter row with Newcastle upon Tyne Hospitals trust, which criticised CHI's methodology.

Its chief executive, Len Fenwick, launched a public attack on CHI, blaming the loss of its three-star status and the chance of becoming a first-wave foundation trust on the way CHI calculated its performance on last year's 26-week outpatients target. And with the disappearance of£1m in Department of Health bonus payments for high-flying three-star hospitals, Newcastle only held back from taking CHI to judicial review because of concerns over spiralling legal costs.

But a CHI spokesman said: 'We looked at Newcastle's performance very closely and we do not think the fate of the trust would have been any different [whether there had been proportional measures or not].'

A CHI spokesman said: 'We have had discussions with trusts about the way last year's ratings were run and decided that these changes should be made because we are committed to improving the reliability of the ratings system.'

And he said that trusts had known they were working to absolute measures on waiting-list breaches last year, under the methodology passed on from the DoH, well before ratings were published.

Mr Fenwick said the battle by his trust had created a fairer system for the service. He told HSJ: 'I am glad that we have won these changes for the NHS and ensured the system is fairer than it was before.'

University Hospitals of Leicester trust was one of 14 acute hospitals given a zero-star rating last summer because it failed on two indicators - accident and emergency performance and inpatient waits.

Chief executive Peter Reading was philosophical about the fact that his trust might have fared better if a proportional system had been in place last year: 'As far as we are concerned It is water under the bridge.What is pleasing is that our staff will know that they are not working at a failing hospital.'

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